Psychosocial school environment and health in Japanese adolescents

Paper : Mental Health Services

Psychosocial school environment, satisfaction withschool, and health complaints among Japanese highschool students
Minoru Takakura*, Norie Wake* and Minoru Kobayashi***
Faculty of Medicine, University of the Ryukyus
207 Uehara, Nishihara, Okinawa, 903-0215 Japan
minoru@med.u-ryukyu.ac.jp**
Faculty of Education, University of the Ryukyus
1 Senbaru, Nishihara, Okinawa, 903-0213 Japan[Received February 10, 2005 ; Accepted April 18, 2005]

This study aims to examine how students’ perception of psychosocial school environment isassociated with satisfaction with school and health complaints among Japanese high school
students. A self-administered questionnaire was conducted with 2,852 students at 25 publichigh schools in Okinawa, Japan. The psychosocial school environment was measured bydemands (unrealistic expectations), student autonomy and control (justice of the rules andparticipation in school activities), and support from teachers and students. Students who
perceived high demands, low control, and low support reported the highest health complaints,
whereas students who perceived low demands, high control, and high support showed thelowest complaints. Each demand-control combination with low support was more likely tohave health complaints than those with high support. The high demands, high control, andhigh support group reported the highest satisfaction, whereas the low demands, low control,and low support group showed the lowest satisfaction. Each demand-control combination
with low support had less satisfaction with school than those with high support. This study
suggests that interventions which improve the psychosocial school environment are needed inorder to promote school-related health.
Keywords: school-related stress, demand, control, support, health and well-being[School Health Vol.1, 1-8, 2005]

1. Introduction
Since students spend their time in the school
setting almost all day, they have a large stake in what
happens to them at school, hence, their reactions
to and perceptions of their school experiences are
significant (Fraser, 1994). Traditionally, school
climate research has involved investigation of
associations between students’ perceptions of
psychosocial characteristics of school and learning
outcomes. Many studies have shown that student
perceptions account for substantial amounts ofvariance in learning outcomes such as achievement,
attitudes, and absenteeism (Anderson, 1982; Fraser,
1994; Moos, 1991).
In the same way, school climate may be considered
to have a significant effect on students’ health
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outcomes. Previous studies have suggested that a
supportive and accepting school environment can bea resource for the development of students’ healthbehaviors, subjective health and well-being, whilea non-supportive and negative school environment
can be a risk factor (Battistich et al., 1997; King etal., 1996; Nutbeam et al., 1993; Samdal et al., 1998a;
Torsheim et al., 2001; Torsheim & Wold, 2001).
School climate research also owes much in theory,
instrumentation, and methodology to earlier workon adult work environment (Rudd & Walsh, 1993).
Although the student role is different from theemployee role (Samdal et al., 1998a), school can be
regarded as a workplace for students. Among adults
the demand-control model by Karasek (1979; 1990)
suggests that job strain occurs when job demands arehigh and control over task content is low (high strain
1

Takakura, M. Wake, N. and Kobayashi, M.

hypothesis) and job satisfaction increases when job
demands and control are simultaneously high (active
learning hypothesis). In addition, an expanded model
including social support proposes that when low
support from managers and colleagues are coupledwith lack of control and high demands at work,
the risk of adverse health outcomes substantially
increases (Johnson & Hall, 1988).
Several studies which employed the demand-control
model in a school setting have been reported. Gadin
and Hammarstrom (2000; 2003) showed that highcontrol in combination with low demand at school
was associated with the best health status from bothcross-sectional and longitudinal perspectives. Samdal
et al (2000) showed that low student autonomy, lowteacher and student support, and inadequate demands
were significantly associated with smoking andalcohol use directly, and indirectly through students’satisfaction with school.
Samdal et al (1998a; 1998b; 1999) also mentioned
how the demand-control-support concept wasapplied into school environment. According to theirview, in a school setting the job demand aspect inadult work environments corresponds to the extent
which teachers and parents expect high academic
performance and good behavior. Unreasonable
expectations, more than the student’s capability, maycause strain. The students’ notion of autonomy andcontrol is formed by rules and the framework for
activities at school, as well as the responsibilities they
are given (Samdal et al., 1998a). If the students do
not feel the justice and relevance of the regulations
and are not allowed to influence the regulation andto participate in activities, they are more likely tohave negative perceptions of school environment.
Social support from managers and colleagues isregarded as from teachers and fellow students. Highteacher support may help students to deal with job
demands and make feel they are cared for. If thestudents perceive high-level support from classmates,
they may feel highly accepted by classmates and asense of belonging in a school context. These social
supports may influence students’ perceptions ofschool as well as have a direct impact on their health.
This study using data from high school students
in Okinawa, Japan, shows how the students’
perception of school environment is related to theirsatisfaction with school and health complaints. The
combined effects of demands/expectations, student
autonomy and control, and support from teachers and2students are measured in order to test the following
hypotheses: 1) students who perceive high demands,
low autonomy and control, and low social support
will report increased health complaints, and 2)
students who perceive high demands, high control
and high support will have better satisfaction withschool.

2. Methods
2.1. Procedures and Subjects
Using written instructions provided by researchers,classroom teachers conducted a self-administered,anonymous questionnaire in a classroom setting inNovember to December 2002. After being informed
about the nature and intent of the study, both inwriting and verbally, students were requested tocomplete and return a questionnaire sealed in an
unmarked envelope to assure confidentiality of the
responses. Students could decline to respond to thequestionnaire. No follow up was conducted withstudents absent from school when the survey was
conducted. The study protocol was approved by the
Medical Ethical Review Board at University of the
Ryukyus.
The study sample consisted of 2,852 students ingrades 10 through 12 (ages 15-18) at 25 public seniorhigh schools throughout Okinawa, Japan. Schools
were chosen from 17 general high schools and eight
vocational high schools depending on the size of thestudent population in school districts and based on
willingness of school administrators to participate
in the study. Questionnaires were collected from2,552 students (1219 males, 1321 females, and 12
unknown). One hundred eleven students declined toparticipate and 189 students were absent from school
when the survey was conducted. Once questionnairesof unknown sex were eliminated, a total of 2,540
remained to be used for analyses.

2.2. Measures
The questionnaire mainly consisted of school
setting questions adapted from the 1997/1998 HealthBehaviour in School-aged Children Study (HBSC) by
the World Health Organization (Currie et al., 2000).
The questionnaire was translated into Japanese by the
research team included a bilingual speaker and werereviewed for content validity by the school principals,
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Psychosocial school environment and health in Japanese adolescentsteachers, school nurses, and researchers. The
psychometric properties of the Japanese questions forJapanese adolescents were determined by Takakura
et al (2002). They showed that Cronbach’s alphacoefficients were reasonable, ranging from 0.50 to
0.84, and test-retest reliability at two-week interval
demonstrated adequate stability, ranging 0.60 to 0.77.
They also found that one dimensionality of each scale
was indicated by the results of principal component
analyses and the predictive validity was confirmedby the correlations between those scales and healthcomplaints.
The school setting measures include the following:
satisfaction with school, unrealistic expectations,student autonomy and control, and support fromteachers and students.
Satisfaction with school was measured by four
items: ‘How do you feel about school at present[anata ha genzai gakkou seikatsu ni tsuite dou omotte
imasuka]’, ‘How often do you think that goingto school is boring [anata ha gakkou ni ikunoga
unzarida to omoukoto ga dorekurai arimasuka]’, ‘Our
school is a nice place to be [watashitachi no gakkou
ha igogochi ga iitokoroda]’, and ‘I feel I belong at
this school [watashi ha kono gakkou no ichiin de aru
to kanjiteiru]’. The first of these items was rated on afour-point scale ranging from ‘not at all’ to ‘like it alot’. Other three items were reported on a five-point
scale ranging from ‘strongly disagree’ to ‘strongly
agree’. The internal consistency of this scale was 0.75
in this study group.
Unrealistic expectations indicate the students’
perceptions of unreasonable job demands in school,
and were measured by two items on a five-point
scale: ‘My teachers expect too much of me at school[gakkou no koto ni tsuite sensei ha watashi ni ohku
o kitai shisugiru]’ and ‘My parents expect too muchof me at school [gakkou no koto nitsuite ryoushin hawatashi ni ohku o kitai shisugiru]’. Cronbach’s alphacoefficient of 0.65 was obtained for this measure.
Student autonomy and control indicate how thestudents feel the justice and relevance of the regulations
and are involved in school activities, and were
measured by five items on a five-point scale: ‘Students
take part in making rules [watashitachi no gakkou
deha seito ga kisokuzukuri ni sanka shiteiru]’, ‘The
rules in this school are fair [kono gakkou no kisoku
ha kouhei de aru]’, ‘Teachers treat us fairly [sensei hawatashitachi o kouhei ni atsukatte kureru]’, ‘Students
are treated too strictly in this school [kono gakkou deha
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seito ga amarinimo kibishiku atsukawareteiru]’, and‘I am encouraged to express my own views in class[kyoushitsu de jibun no iken o hyougen suruyou
sensei ha hagemashite kureru]’. Cronbach’s alphacoefficient was 0.63 in this sample.
Teacher support consisted of two items: ‘When
I need extra help from my teachers, I can get it[watashi ga tokubetsu no tasuke o hitsuyou tosurutoki sensei ha tasukete kureru]’ and ‘My teachers
are interested in me as a person [sensei ha hitori
no ningen to shite watashi ni kanshin o shimeshite
kureru]’. Student support consisted of three items:‘Students in my class enjoy being together [watashi
no kurasu no seito ha issyo ni iruto tanoshii]’,‘Students in my class are kind and helpful [kurasu
no hotondo no seito ha shinsetsu de tayori ni naru]’,and ‘Other students accept me [ta no seito ha watashi
o ukeirete kureru]’. These questions were rated ona five-point scale and were added up to provide thescale score of support from teachers and students.
Cronbach’s alpha coefficient was 0.76 in this study
group.
Health complaints were measured by the HBSC
symptom checklist included the items headache,abdominal pain, backache, feeling low, irritability,
nervousness, sleeping difficulties, and dizziness.
Students reported on a five-point scale if each
symptom was experienced seldom or never, about
once every month, about once every week, morethan once a week, or most days. Sum scores were
calculated for each student. Cronbach’s alphacoefficient was 0.77 in this study group.
In addition, demographic variables including
gender, grade, and school type were assessed.
The students’ perceptions of their family wealthand academic achievement were also measured ascontrols in the analyses. Based on a conveniencesample of 240 Japanese high school students in 2001,
test-retest at two-week interval showed intra-classcorrelations of 0.80 and 0.70, respectively.

2.3. Data analysis
The unrealistic expectations, student autonomy
and control, and support scale scores were classified
into two groups based on each median. These
groups were combined into a single measure witheight categories, which generated the interactionsof high and low levels of demands, autonomy andcontrol, and support. In the text, these categories
3

Takakura, M. Wake, N. and Kobayashi, M.

Table 1 Health complaints and satisfaction with school by demographic variables
Total
Grade

Health complaints
n
Mean
SD
F/t
2439
14.5
5.9

p

Satisfaction with schooln
Mean SD
F/t
2487
11.9 3.2

p

10th
11th
12th

852
864
723

14.5
14.5
14.4

5.9 0.02
5.8
5.9

0.979

876
874
737

12.2
11.6
11.8

3.1
3.1
3.2

8.89

<0.001

Male
Female

1158
1281

13.3
15.5

5.3 -9.64
6.2<0.001

1186
1301

11.9
11.9

3.1 -0.15
3.2

0.881

General H.S.
1660
Vocational H.S.
779
Family wealth155
Very well off
369
Quite well off
1240
Average524
Not very well off
106
Not at all very well off
Academic achievement
34
Very good
174
Good
1362
Average738
Bad
116
Very bad
Total number varies because of missing data.

14.6
14.3

5.9 1.04
5.8

0.296

1695
792

12.2
11.3

3.1
3.2

6.14

<0.001

14.2
13.9
14.0
15.5
17.1

5.4 12.30
5.5
5.7
6.1
7.1

<0.001

162
381
1261
536
110

13.2
12.5
12.0
11.3
10.2

3.4 24.03
3.0
3.1
2.9
3.9

<0.001

14.0
14.3
14.0
15.2
15.9

7.0
5.3
5.6
6.2
5.9

<0.001

36
181
1378
757
120

12.0
12.4
12.2
11.5
9.8

3.9 22.50
3.3
2.9
3.2
3.7

<0.001

GenderSchool type

7.19

Table 2 Descriptive statistics of school environment variables
TotalnMean SD Median
Unrealistic expectations
2503
5.1
1.6
5
Student autonomy & control
2505
13.9
3.4
14
Teacher & Student Support
2483
17.5
3.9
18
Total number varies because of missing data.

were characterized with capital letters of high andlow levels of demands, autonomy and control, andsupport in turn. For example, HLL indicates students
who perceived high demand, low control, andlow support. Analyses of covariance (ANCOVAs)
were conducted separately for health complaints
and satisfaction with school. For each analysis, theindependent variable was the combination measureof demands, autonomy and control, and support, andthe covariates were grade, gender, school type, family
wealth, and academic achievement. A criterion of
p<0.05 for statistical significance was applied. In thecase of multiple comparisons, we applied the more
stringent criterion of p<0.001 for significance due totype I error.

3. Results
The mean scores of health complaints andsatisfaction with school are provided in Table 1.
Females had more health complaints than males.
4

Male
n
Mean SD Median
1194
5.3
1.6
5
1196
14.1
3.5
14
1187
17.4
3.9
18

FemalenMean SD Median
1309
5.0
1.6
5
1309
13.7
3.4
14
1296
17.7
3.9
18

There were no differences in health complaints bygrade and school type. The youngest students andgeneral high school students were more likely to besatisfied with school. There was no gender differencein satisfaction with school. Poorer students had more
health complaints and less satisfaction with school.
Students who perceived bad academic achievement
were more likely to report health complaints and to
be dissatisfied with school.
Table 2 shows the descriptive statistics of
unrealistic expectations, student autonomy andcontrol, and support from teachers and students. As
the medians of each scale did not vary by gender,these scale scores were dichotomized at the medianfor the total sample. Later analyses were conductedby the use of total sample data.
A result of ANCOVA on health complaints ispresented in Table 3. High demand, low control, andlow support group (HLL) reported the highest healthcomplaints, whereas low demand, high control,and high support group (LHH) showed the lowest
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Psychosocial school environment and health in Japanese adolescents

Table 3 The results of ANCOVA on health complaints and satisfaction with school
Combinations

n

Mean

SE

F

LHH
HHH
LLH
HLH
LHL
HHL
LLL
HLL

385
486
201
194
251
219
385
229

12.3
13.7
13.9
14.9
15.0
15.4
15.7
16.3

0.3
0.3
0.4
0.4
0.4
0.4
0.3
0.4

16.89 <0.001

Health complaints¶pMultiple comparisons

LHH<HLH,LHL,LLL,HHL,HLL
HHH<LLL,HLL
LLH<HLL

Satisfaction with school

LLL
388
9.6 0.1 121.30 <0.001 LLL,HLL<LLH,HLH,LHL,HHL<LHH,HHH
HLL
233
9.7 0.2
LHL
268 11.4 0.2
HHL
224 11.6 0.2
LLH
207 11.7 0.2
HLH
197 12.4 0.2
LHH
396 13.5 0.1
HHH
497 13.8 0.1
Total number varies because of missing data.
�Combinations of demand, control, and support�Adjusted for grade, gender, school type, family wealth, and academic achievement¶
�Bonferroni test (p<0.001)
LHH�low demand, high control, and high support group
LLH�low demand, low control, and high support group
HHH�high demand, high control, and high support group
HLH�high demand, low control, and high support group
LHL�low demand, high control, and low support group
LLL�low demand, low control, and low support group
HHL�high demand, high control, and low support group
HLL�high demand, low control, and low support groupcomplaints. Each demand-control combination withlow social support was more likely to have healthcomplaints compared to those with high social
support. Within the high social support condition,high demand-low control group (HLH) had
significantly more complaints than low demand-highcontrol group (LHH). Within the low social supportcondition, no combinations significantly differed inhealth complaints.
Table 3 also contains a result of ANCOVA on
satisfaction with school. High demand, high control,and high support group (HHH) reported the highest
satisfaction, whereas low demand, low control, and low
support group (LLL) showed the lowest satisfaction.
Each demand-control combination with low social
support had less satisfaction with school than thosewith high social support. Both in high and low levels ofsocial support, high demand-high control groups (HHH,
HHL) were significantly more satisfied with school
than low demand-low control groups (LLH, LLL).
Similarly, low demand-high control groups (LHH,
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LHL) were significantly more satisfied with school thanhigh demand-low control groups (HLH, HLL).

4. Discussion
This study showed that the combined measure ofdemands, control, and support was associated withhealth complaints and satisfaction with school among
Japanese high school students.
In this study, it is hypothesized that students who
perceive high-school strain, that is high demands
and low control conditions, may report increased
complaints compared with those who perceived low
demands and high control, and health complaints
at high demands and low control condition may
increase as the level of social support decreases.
Our findings supported this hypothesis if highsocial support was provided. The combined effectof demands and control on health complaints wasevident only if social support was present. On theother hand, in the low support condition, there was5

Takakura, M. Wake, N. and Kobayashi, M.

no difference in health complaints among eachdemand-control combination. A possible explanation
could be that the adverse impact of low social support
surpasses that of demand and control on healthcomplaints. Thus, no matter how students perceived
demands and control, if their social support fromteachers and students was lacking, their risk forhealth complaints greatly increased. As Japaneseculture is collective and mutually cooperative,the existence of social support may be extremely
important (Markus & Kitayama, 1991). Previous
studies in Japanese high school students also foundthat lack of social support was significantly related tomore stress responses, such as depression and anxiety(Okayasu et al., 1992; Takakura et al., 1998). Anotherexplanation may be due to our measurement ofstudent autonomy and control. As this scale includes
a small number of items concerning teachers, which
can be construed as another component of teacher
support, it is possible that the effect of autonomy andcontrol may accentuate as the level of teacher support
increases. Johnson and Hall (1988) showed that, withfew exceptions for each demand-control combination,
prevalence rates of cardiovascular disease increase
with decreasing levels of social support. However,
the high demand-high control combination with lowsocial support showed the highest prevalence rate.
They suggest that their indicator of control may bemeasuring responsibility, which in some occupations
might constitute another component of job demands.
Adult job strain research also reported consistentfi n d i n g s t h a t t h e c o m b i n a t i o n o f h i g h j o bdemands and low control was associated with job
dissatisfaction (Karasek, 1979). In addition, it was
revealed that there was a complex interaction of job
demand and control effects on job dissatisfaction,that is, when job demands and control were
simultaneously high, the level of job dissatisfaction
decreased (Karasek, 1979). In the demand-control
model, this condition is called "active job" in awork context and the opposite condition with low
demand and low control is "passive job". Thisphenomenon is explained by the active-learning
hypothesis that learning is predicted to occur mostoften when the challenges in the situation arematched by the individual’s control over alternatives
or skills in dealing with those challenges, leading
to development of new behavior patterns and highlevels of job satisfaction (Karasek & Theorell, 1990).
The highest satisfaction occurs with an "active
6

job", where both the challenge of high job demands
and the opportunity for significant use of judgment
and discretion are available (Karasek, 1979).
Interestingly, this study also showed that students
who perceived high demands and high control weremore likely to be satisfied with school than thosewith low demands and high control or low demands
and low control. These findings were consistent
with the findings of the adult working populationand supported the active-learning hypothesis. In thisstudy, the job demands in school were expressedby teachers’ and parents’ expectations of thestudents, which they perform well. Thus, expressed
expectations may be a positive motivation to do
one’s best. Moreover, increased social support may
promote an aspiration or desire to improve oneself.
In such a context, students are more likely to be
reinforced to do their best, to develop an interest in
the topics addressed in school, and also feel satisfied
with school (Samdal et al., 1999). By contrast, low
expectations from teachers and parents may reduce
motivation to perform. The findings of the adultwork environment studies suggest that employeeswith low job demands and low control face thedifferent problem of passivity and apathy (Gadin &Hammarstrom, 2000). In this study, students with low
demands, low control, and low support had the lowest
satisfaction with school.
School climate research has been often conductedin accordance with Moos’s scheme for classifying
human environments: Relationship Dimensions,which identify the nature and intensity of personal
relationships within the environment and assess
the extent to which people are involved in theenvironment and support and help each other(e.g., support, cohesion); Personal Development
Dimensions, which assess basic directions along
which personal development and self-enhancement
tend to occur (e.g., competition, academic
achievement); and System Maintenance and Change
Dimensions, which involve the extent to which
the environment is orderly, clear in expectations,maintains control, and is responsive to change (e.g.,organization, control) (Fraser, 1982; Moos, 1973;
1991). The characteristics of the school environment
scales used this study can be considered as partsof these dimensions. The unrealistic expectations
may be related to the Personal Development
Dimension. Student autonomy and control can be
regarded as the System Maintenance and Change
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Psychosocial school environment and health in Japanese adolescents

Dimensions. Teacher and student support is a partof the Relationship Dimensions. It must, however,be added that these variables do not represent all
aspects of Moos’s three types of dimensions. In
Japan, some researchers developed the school climate
scale based on Moos’s scheme (Hirata & Sako, 1999;
Ito & Matsui, 2001). Although the perceptions ofschool climate among Japanese junior high school,
non-attendant and delinquent students were described(Hirata & Sako, 1999), it is unclear how students’
perceptions of the school environment are associatedwith their health outcomes.
Samdal et al (1999) showed that school
environments seemed to explain more variance inacademic achievement among students in Western as
opposed to Eastern Europe. They considered that thereason for this result was found in the lower internalconsistency of the school environment scales forEastern Europe, suggesting the scales might havebeen less appropriate for school system in Eastern
Europe than in the West (Samdal et al, 1999). In
this study, alpha coefficients on the unrealistic
expectations and student autonomy and control were
somewhat low. It is possible that these scales may notgrasp precisely the concepts of school environmentsin the West, and that there may be cultural differencesin students’ perceptions of the school environment.
Student autonomy and control is not especiallycommon in Japan, as the Japanese school systemis structured in a uniform educational fashion andJapanese students are tied down by long school hours
and strict rules compared with the Western students(Lock, 1986; Sengoku, 1998). Therefore, the findings
must be interpreted cautiously when conducting
cross-cultural comparisons.
It has been shown that factors other than demandand control might be even more important forschool-related health in young age groups (Gadin &Hammarstrom, 2000). Although socio-demographic
variables were adjusted in this study, other possible
confounders such as the student’s personality andbullying problems need to be controlled in future
research. Another limitation is the cross-sectional
study design. Clearly our data cannot provide any
information about causal linkages between school
environment and health.
In conclusion, the combined effect of demand,autonomy and control, and teacher and student
support was found to be related to health complaints
and satisfaction with school among Japanese
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high school students in Okinawa. In addition, as
students with high demand, low control, and low
support reported the most health complaints andhigh demand, high control, and high support groupreported the highest satisfaction with school, it may
be supportive of the demand-control-support model
for adult work environment. This study suggeststhat interventions which improve the psychosocial
school environment are needed in order to promoteschool-related health.
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Name:

Minoru Takakura, Ph.D.
Affiliation:
Faculty of Medicine, University of the
Ryukyus

Address:
207 Uehara, Nishihara, Okinawa, 903-0215 Japan
Brief Biographical History:
1983- Research Assistant, Division of General Education,
University of the Ryukyus
1988- Assistant Professor, Division of General Education,
University of the Ryukyus
1993- Associate Professor, Division of General Education,
University of the Ryukyus
1997- Associate Professor, Faculty of Medicine, University of the
Ryukyus2005- Professor, Faculty of Medicine, University of the Ryukyus
Main Works:• Association of age at onset of cigarettes and alcohol use
with subsequent smoking and drin king patter ns among
Japanese high school students. Journal of School Health.
Vol.73,226-231.(2003).
Membership in Learned Societies:• Japanese Association of School Health• Japan Epidemiological Association• Japanese Society of Public Health

School Health Vol.1, 1-8, 2005
http://www.shobix.co.jp/sh/hp/main.htm